Healthcare Provider Details

I. General information

NPI: 1184824476
Provider Name (Legal Business Name): KATHLYNN JON STULL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 NILES RD
SAINT JOSEPH MI
49085-3355
US

IV. Provider business mailing address

2820 NILES RD
SAINT JOSEPH MI
49085-3355
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-1982
  • Fax: 269-556-9615
Mailing address:
  • Phone: 269-429-1982
  • Fax: 269-556-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008480
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: